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NPI Code Detail

MEDICARE: DR. DAIL WILSON LONGAKER MD

MEDICARE:  DR. DAIL WILSON LONGAKER  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician4865SC

General Provider Information

NPI Number : 1356537500
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAIL WILSON LONGAKER MD
Provider Business Mailing Address
First Line : 4614 PERRY CT
Second Line :
City : COLUMBIA
State : SC
Zip : 29206-4516
Country : US
Telephone Number : 803-782-4549
Fax Number :
Provider Business Practice Location Address
First Line : 4614 PERRY CT
Second Line :
City : COLUMBIA
State : SC
Zip : 29206-4516
Country : US
Telephone Number : 803-782-4549
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2007
Last Update Date : 09/21/2007

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Directions to “ DR. DAIL WILSON LONGAKER MD” Practice Location

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